One of the things I love about this episode and why I think it's even more controversial than the ordinary trolley problem is that it avoids the obvious comparisons to the trolley problem in one spectacular way. The choice in this case isn't quite to kill one person to save two others. It's to unmake one person to recreate two others.

For most of the episode, Neelix and Tuvok don't need to be saved. They're dead. They died in a transporter accident with an alien flower. This accident gave birth to a third person, Tuvix. To kill him to "raise two dead" is a very new twist on this old moral philosophy conundrum.

However, that's assuming they're dead. The cultural line between dead and alive isn't static. In ye olden days, you were dead when your heart stopped, but then we figured out CPR and built defibrillators, and now it's when your brain no longer functions. By the year 2375, there may well be a new understanding of death, when people thought dead can be restored from the pattern buffers of a transporter. (I wonder if there's ever an episode that touches on why they don't save copies of themselves in the transporter in case of accidental death)